Healthcare Provider Details

I. General information

NPI: 1043088677
Provider Name (Legal Business Name): SUPPORT YOU MENTAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4830 W KENNEDY BLVD STE 600
TAMPA FL
33609-2584
US

IV. Provider business mailing address

6421 N FLORIDA AVE # D-1942
TAMPA FL
33604-6007
US

V. Phone/Fax

Practice location:
  • Phone: 727-410-5818
  • Fax:
Mailing address:
  • Phone: 727-410-5818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANNIELLE TIMMONS
Title or Position: CEO,SPEAKER/THERAPIST
Credential: LCSW
Phone: 727-410-5818